PSMA-Targeted Therapy

What is PSMA-targeted therapy?

Prostate-specific membrane antigen (PSMA)-targeted therapy is a type of normal cancer therapy. It uses a radioactive tracer (radiotracer) to target and destroy PSMA, which is a protein on the outside of prostate cancer cells.

The prostate is a gland that rests below the urinary bladder and in front of the rectum. It’s about the size of a walnut.

Other names for PSMA-targeted therapy may include lutetium PSMA therapy and Lu177-PSMA (Pluvicto™).

What is PSMA?

PSMA is a protein and an antigen. Antigens are substances that cause your immune system to respond. They include bacteria, viruses, allergens, tumor cells and even normal cells. Prostate cancer cells make PSMA.

What conditions are treated with PSMA-targeted therapy?

PSMA-targeted therapy treats advanced prostate cancer that doesn’t respond to surgery or radiation, especially cancer that breaks away and forms new tumors in other parts of your body (metastatic prostate cancer).

Does PSMA-targeted therapy cure prostate cancer?

No, PSMA-targeted therapy doesn’t cure cancer. PSMA-targeted therapy’s goal is to reduce your symptoms, shrink your tumors and slow tumor growth.

A cure means you no longer have prostate cancer, you don’t need any more treatment and healthcare providers don’t think it’ll return. With PSMA-targeted therapy, you’ll need follow-up care, regular check-ups and periodic testing. After treatment, you may have a longer remission period, which means you’re symptom-free and tests show no signs of active cancer.

What happens before PSMA-targeted therapy?

Before PSMA-targeted therapy, most people have other standard prostate cancer treatments, including chemotherapy, hormone therapy and chemical castration. If the cancer doesn’t respond to these treatments, your healthcare provider may recommend PSMA-targeted therapy.

Before starting treatment, your provider will review your medical history and perform a physical examination. Be sure to bring a list of your previous treatments, current medications and any questions you may have.

Your provider will also order blood tests and imaging tests. Imaging tests may include:

• A CT (computed tomography) scan. A CT scan creates a 3D image of your soft tissues and bones.
• Magnetic resonance imaging (MRI). An MRI uses large magnets, radio waves and a computer to make detailed images of the soft tissues in your body.
• Prostate-specific membrane antigen positron emission tomography (PSMA PET) scan. A PSMA PET is a type of PET scan that works like PSMA-targeted therapy. It uses a radiotracer to find and attach to PSMA proteins, which are then visible on the scan.

These imaging tests work together to help your providers see exactly where prostate cancer cells reside in your body.

What happens during PSMA-targeted therapy?

During PSMA-targeted therapy, a healthcare provider uses a small needle to inject a standard PSMA dosage into a vein, usually in your arm. The PSMA therapy dose contains lutetium-177. Lutetium-177 is a radioactive chemical element that destroys prostate cancer cells. The PSMA therapy dose takes the lutetium-177 directly to your prostate cancer tumors so that the radiation will have minimum effect on other parts of your body.

The injection process usually takes just a few minutes.

The provider may give you medications that help treat nausea and vomiting.

PSMA-targeted therapy is an outpatient procedure, meaning that you can go home the same day. Your providers will observe you after the procedure. Once they determine you’re healthy enough after the treatment, you can go home.

How long will I need PSMA-targeted therapy?

You’ll schedule treatments every six weeks for six total treatments. In between each session, your healthcare providers will conduct blood tests to see how well you’re responding to treatment and assess any side effects.

If you respond well to PSMA-targeted therapy, you should finish treatment after 36 weeks (a little over eight months).

What are the potential benefits of this treatment?

The primary benefit of PSMA-targeted therapy is that it helps treat prostate cancer, slows the spread of disease and improves prostate cancer symptoms.

Another benefit of PSMA-targeted therapy is that it only targets the high levels of PSMA in prostate cancer cells. This reduces damage to other healthy cells in your body.

What are the risks or complications of PSMA-targeted therapy?

All cancer treatments have side effects. The most common side effects of PSMA-targeted therapy include:

• Dry mouth (xerostomia).
• Dry eyes.
• Fatigue.
• Nausea and vomiting.
• Loss of appetite.
• Pain.
• Lower hemoglobin levels.
• Lower platelet counts.

How long will it take for me to feel better after PSMA-targeted therapy?

Your body is unique, and how you respond to PSMA-targeted therapy may differ from others. Some people who go through the treatment continue their routines without any problems. Others feel sick and may need to rest for at least a few days.

Talk to your healthcare provider about what to expect. Ask them what the best- and worst-case scenarios are so you can adjust your schedule around treatments.

Is there anything I can do to make PSMA-targeted therapy easier on me?

The following tips may help you as you go through PSMA-targeted therapy:

Get rest

It can be difficult to sleep or collect your thoughts after a prostate cancer diagnosis. This is especially true if the cancer doesn’t respond to other types of treatment you may go through before PSMA-targeted therapy. A lack of sleep can affect your mood and make it harder to deal with the stress that occurs during your treatment.

It’s a good idea to avoid large meals, caffeine and alcohol before bed. Meditation and keeping a journal or diary can help you process your thoughts and feelings, which can help relieve insomnia.

Rest when your body tells you to, not just when you can.

Be physically active when you feel up to it

If you’re already physically active and you feel up for it, light exercise can help maintain heart and lung fitness, prevent muscle loss, boost your immune system and relieve feelings of fatigue, stress and depression.

Be sure to talk to your healthcare provider before you start any physical activities while going through PSMA-targeted therapy.

Eat a well-balanced diet

Nausea and vomiting can be side effects of PSMA-targeted therapy. Eating a well-balanced diet can help ensure you get the necessary vitamins and minerals. This may include:

• Lean proteins.
• Vegetables.
• Fruit.
• Whole grains.
• Low-fat dairy.

You and your healthcare provider can work together to determine the best foods to eat. They may refer you to an oncology-certified dietitian. An oncology-certified dietitian is a special healthcare provider who helps establish the best diets for people going through cancer treatments.

Get the support you need

You may experience a lot of feelings during your prostate cancer treatment. You don’t need to work through your feelings alone. Talking about your feelings to a family member or close friend may be helpful. You can also ask your healthcare provider if there are any mental health professionals or support groups they can recommend for people who have prostate cancer.

When should I call my healthcare provider?

Schedule regular follow-up appointments with your healthcare providers. They’ll conduct blood tests and review any symptoms to determine how well you’re responding to treatment.

Talk to your healthcare provider if you experience any PSMA-targeted therapy side effects.

Has PSMA-targeted therapy been approved by the FDA?

Yes, the United States Food and Drug Administration (FDA) approved PSMA-targeted therapy in 2022.

Is PSMA-targeted therapy covered by Medicare?

Talk to your healthcare provider. The coverage may depend on your insurance, what your provider charges for the therapy and where you get your treatment. A patient financial coordinator may also be able to help estimate the cost of your treatment and discuss whether you’re eligible for government or other financial assistance programs.

A note from Cleveland Clinic

Receiving a prostate cancer diagnosis and going through treatment is difficult, especially if it doesn’t respond to other treatment options or spreads to other areas of your body. If you have prostate cancer, ask your healthcare provider if PSMA-targeted therapy is an option for you. It allows your provider to deliver radiation that targets and destroys only the prostate cancer cells while sparing healthy tissues.